About TIDE
What Does Depression Look Like?
Logan has not been feeling like himself for the past two months. He has lost his interest in his old hobbies and doesn't feel excitement for things that used to be fun. He feels like he's just going through the motions, and everything seems much harder than it used to. Sports, friends, and school have all started to feel like a chore. He feels deeply sad, empty, and drained of energy most of the time. It's been getting worse, and his friends and family are worried about him.
Logan's story might be familiar. Maybe you've been feeling this way, or you might know someone else going through something similar. This is just one example of what depression can look like. If you notice these symptoms and don't feel that they are improving, depression might be the cause.
Symptoms of depression can interfere with the education, relationships, and careers of young people. Serious depression can make every day a challenge or cause a person to lose their will to live.
Some symptoms of depression are feelings that everyone encounters from time to time in their life. Depression can be experienced as more than just a feeling of sadness, and can look different from person to person.
When certain thoughts, feelings and behaviours occur at the same time and for longer periods, they can have a big negative impact on a person’s life and well-being that can be very challenging to overcome alone.
Getting the right treatment early on can make all the difference in helping people recover from depression and stay well in the long term.
Depression is most often experienced for the first time in early adulthood,¹ at a time when important life decisions are being made. Prompt, effective treatment at this stage can be critical to help people feel better in the short term, and to set young people up for socially, academically and professionally successful and fulfilling futures.
¹ Moffitt TE, Caspi A, Taylor A, Kokaua J, Milne BJ, Polanczyk G, et al. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol Med 2010; 40: 899–909.
Why TIDE?
For a young person experiencing depression for the first time, getting effective treatment is not straightforward. Many medications and therapies are available to treat depression, but no single treatment works for everyone. It can be a real challenge to know where to get help, and even then, there is no guarantee that the treatment offered will be a good fit. If that first attempt at treatment is effective, it is possible to quickly return to feeling like yourself again, and catch up on what you missed, but ineffective treatment can lead to frustration and hopelessness.
TIDE aims to find out which treatment works for whom. Who needs medication to recover, and who does well with psychological treatment alone? TIDE is the first project of its kind that aims to determine which factors can help predict the success of different initial treatment plans for young people who are experiencing depression for the first time.
Getting the information that matters
We know sitting through long tests isn’t fun. It can be even more of a burden for someone experiencing depression. Other than treatment visits with a study clinician or therapist, participation in TIDE also involves several kinds of assessments. Your comfort and well-being are very important to us. We always aim to keep TIDE visits as efficient and convenient as we can, while collecting important information to answer our research questions. The data collected includes measures related to your health, brain activity, speech behaviour, sleeping and physical activity and personal experiences.
EEG
We use a lightweight EEG (electroenecephalograpy) device to record natural brain activity while the participant is speaking and while at rest.
Speech sample
We record a short speech sample during the EEG to examine how depression affects how people talk.
Blood test
We do a blood test to check your overall health, confirm safety of potential treatment, and to look for biological markers that may be specific to people with depression.
Sleep activity
You'll be asked to wear an actigraph (a watch-like device that records movement and light) to track your sleep and physical activity over two 2-week periods.
Over the course of your treatment, you'll also be asked about your symptoms and personal experiences, and to fill in questionnaires on your own to get a sense of how you're doing.
Everything that you share with us is completely confidential, and your data will be using an anonymous ID. Please contact us for more information about how we protect your privacy.
Therapy or medicine?
Every eligible TIDE participant is offered active treatment.
We are using the psychological treatments and antidepressant medication that are supported by strongest evidence for benefits and safety in young people.
We know that the treatments we offer work well on average, but that information becomes less useful when making treatment decisions for one specific person.
Because we want to figure out who benefits from these two types of treatment individually, you will first be assigned to receive either cognitive behavioural therapy or antidepressant medication. The goal with both types of treatment is to see a major improvement in how you're feeling. There may be the option of switching to or adding on the other treatment option if the first one we try does not significantly improve your symptoms.
Who can participate?
✅ Age 12-24
✅ First time experiencing depression
✅ No previous treatment for depression
Additional eligibility criteria will be assessed by the TIDE team. If you are between ages 12 and 24, think you are experiencing depression for the first time in your life, and haven't received treatment for it yet, you can either self-refer or discuss a referral with your doctor. If you are older than 24 (25 and above) of if this is not the first time you are experiencing depression, you may be still eligible for another project.
TIDE has been reviewed and approved by the NS Health Research Ethics Board (REB), The IWK REB and by Health Canada. All potential participants will be given detailed information about what they can expect before joining TIDE.
If you are interested in learning more about TIDE or think you might be eligible, please contact the TIDE team.
What's next?
If you think you might be eligible, we encourage you to call the TIDE office, submit a contact form or talk to your doctor about participating in TIDE.
Step 1: After you, your parent/guardian or your GP has reached out, we will arrange a pre-screening conversation. This can be done over the phone or in person, and is an opportunity for you to get any questions you have about the project answered. In turn, we will get a sense whether TIDE is likely to be a good fit for you based on some preliminary questions we will ask you.
Step 2: If you seem likely to be eligible and want to proceed, the next step is a screening visit. At this appointment, you will review all the information about the project and what your participation would look like with a TIDE team member. You will also meet with one of the TIDE clinicians to make sure you fit the eligibility criteria in full.
Step 3: If you and the clinician both feel that TIDE is a good fit, we will move on to the baseline assessment, which includes some self-report questionnaires, a brief interview and collection of biometric data.
At this point, you will be randomized into the study. This means that you will be assigned either to the psychological treatment group, or the antidepressant medication group. You have a 50/50 chance of being assigned to one or the other; we have no input into which group you will be assigned to at first.
For both groups, initial treatment will last 16 weeks, with check-ins every two weeks. Depending on how you're doing, further treatment can be considered, which will be decided between you and the study clinician. We would like to continue to follow-up with you every three months for up to 2 years.